uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
A 10-year follow-up of tailored behavioural medicine treatment and exercise-based physiotherapy in persistent musculoskeletal pain
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
Res & Dev Ctr Spenshult, Halmstad, Sweden.; Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Show others and affiliations
2017 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 2, 186-196 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.

Place, publisher, year, edition, pages
2017. Vol. 31, no 2, 186-196 p.
Keyword [en]
Chronic pain, behavioural medicine, primary care, physical exercise, long-term compliance
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-281461DOI: 10.1177/0269215516639356ISI: 000394758500005PubMedID: 27009057OAI: oai:DiVA.org:uu-281461DiVA: diva2:914458
Funder
Swedish Rheumatism Association
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2017-08-22Bibliographically approved
In thesis
1. Long-term perspectives on musculoskeletal pain: Health care utilization and integration of behavioral medicine treatment into physical therapy
Open this publication in new window or tab >>Long-term perspectives on musculoskeletal pain: Health care utilization and integration of behavioral medicine treatment into physical therapy
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.

Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.

Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.

Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 83 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1360
Keyword
Chronic pain, health care utilization, behavioral medicine, stratified treatment, prognostic factors, physical therapy, primary care
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-328363 (URN)978-91-513-0044-3 (ISBN)
Public defence
2017-10-13, A7:107a, Biomedicinsk centrum, Husargatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-09-21 Created: 2017-08-22 Last updated: 2017-10-17

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Emilson, ChristinaDemmelmaier, IngridLindberg, PerÅsenlöf, Pernilla

Search in DiVA

By author/editor
Emilson, ChristinaDemmelmaier, IngridLindberg, PerÅsenlöf, Pernilla
By organisation
PhysiotherapyDepartment of Psychology
In the same journal
Clinical Rehabilitation
Physiotherapy

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 574 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf